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This is VAERS ID 955312

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 955312
VAERS Form:2
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This individual is an EMS first responder who volunteers within our EMS system. She arrived at our clinic during a event to receive a vaccination. Unfortunately, she was advised that she could receive a vaccine with her mothers consent by our County Emergency Manager. A consent was obtained and she was lead to the clinic injection area. Once there, her consent form was reviewed and all of her screening questions were checked no. At this point in time, on the first day, we did not include a yes/no question confirming everyone was over 18 because its was only select recipients. The mistake was noticed immediatly and reported to the recipients mother who was also on site. It was explained the vaccine administered does not have an EUA for 16-18 year-olds. The county OMD was also notified at this time. The recipient did not have any reactions post inoculation. A followup call was placed later in the day to confirm she still did not experience any signs or symptoms, which she had not. We where able to identify the root cause of this event and have implemented a number of new safety measures to ensure we do not have a repeat event.


Changed on 5/7/2021

VAERS ID: 955312 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This individual is an EMS first responder who volunteers within our EMS system. She arrived at our clinic during a event to receive a vaccination. Unfortunately, she was advised that she could receive a vaccine with her mothers consent by our County Emergency Manager. A consent was obtained and she was lead to the clinic injection area. Once there, her consent form was reviewed and all of her screening questions were checked no. At this point in time, on the first day, we did not include a yes/no question confirming everyone was over 18 because its was only select recipients. The mistake was noticed immediatly and reported to the recipients mother who was also on site. It was explained the vaccine administered does not have an EUA for 16-18 year-olds. The county OMD was also notified at this time. The recipient did not have any reactions post inoculation. A followup call was placed later in the day to confirm she still did not experience any signs or symptoms, which she had not. We where able to identify the root cause of this event and have implemented a number of new safety measures to ensure we do not have a repeat event.


Changed on 5/21/2021

VAERS ID: 955312 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This individual is an EMS first responder who volunteers within our EMS system. She arrived at our clinic during a event to receive a vaccination. Unfortunately, she was advised that she could receive a vaccine with her mothers consent by our County Emergency Manager. A consent was obtained and she was lead to the clinic injection area. Once there, her consent form was reviewed and all of her screening questions were checked no. At this point in time, on the first day, we did not include a yes/no question confirming everyone was over 18 because its was only select recipients. The mistake was noticed immediatly and reported to the recipients mother who was also on site. It was explained the vaccine administered does not have an EUA for 16-18 year-olds. The county OMD was also notified at this time. The recipient did not have any reactions post inoculation. A followup call was placed later in the day to confirm she still did not experience any signs or symptoms, which she had not. We where able to identify the root cause of this event and have implemented a number of new safety measures to ensure we do not have a repeat event.

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